Findings from animal models suggest early exposure to polyunsaturated fatty acids (PUFAs) during pregnancy may influence developmental plasticity including adiposity(1). Birth cohort studies examining associations between offspring weight and maternal n-3 PUFA status or maternal fish intakes, the richest dietary source of n-3 PUFAs have been few and have yielded inconsistent findings. Some have reported lower weight at birth and throughout childhood with increasing maternal fish intakes and n-3 PUFA status(2), whilst others have observed positive or null associations(3,4). These have focused on the first few years of life and have been conducted within low fish-consuming populations. Our study provides novel data by examining associations between maternal fish consumption and prenatal PUFA (n-3 & n-6) status and offspring weight at birth and throughout childhood (7 & 13 years) in a high fish-eating population.

Pregnant women were enrolled in the Seychelles Child Development Study Nutrition Cohort 2 between 2008-2011. Serum PUFAs were quantified in maternal blood collected at 28-weeks’ gestation and in cord blood collected at delivery using gas-chromatography tandem mass spectrometry. Maternal fish consumption was assessed at 28-weeks’ gestation using a Fish Use Questionnaire. Childbirth weight (kg) was measured at delivery and classified according to WHO growth standards(5) (n = 1185). Child height (m), weight (kg), waist and hip circumference (cm) were recorded at 7 (n = 1167) and 13 (n = 878) years. Statistical analysis was conducted using logistic and multiple linear regression adjusting for child sex, gestational age, maternal age, BMI, alcohol use, socioeconomic status, and parity. Models at 7 & 13 years were additionally adjusted for child height and fish intakes.

Women were consuming on average 8.49 ± 4.51 fish meals/week during pregnancy. No significant associations were found between maternal fish intakes and anthropometric outcomes at birth, 7 & 13 years. No significant associations were observed between maternal PUFAs and offspring weight at birth. At both 7 & 13 years, however, higher maternal total n-6 PUFAs were associated with increased child weight [7yr; β = 0.070, p = 0.003, 13yr; β = 0.097, p = 0.004], waist circumference [7yr; β = 0.086, p = 0.003, 13yr; β = 0.105, p = 0.004], and hip circumference [7yr; β = 0.062, p = 0.027, 13yr; β = 0.090, p = 0.013]. No significant associations were found between cord n-6 PUFAs and birth weight. In quartile analysis, cord docosahexaenoic acid (DHA; C22:6n-3) concentrations <0.071mg/ml were associated with a higher risk of large for gestational age (LGA; >90th percentile) when compared to cord DHA concentrations >0.129mg/ml [OR 4.17, p = 0.017]. There were no significant associations between cord PUFAs and anthropometric outcomes at 7 & 13 years.

These findings suggest lower cord DHA, an n-3 PUFA, may be associated with higher risk of LGA at birth whilst higher n-6 PUFAs during pregnancy may be associated with adiposity development throughout childhood. Future work is needed to determine the potential long-term metabolic consequences of such associations.

It is well-known that many modern lifestyles, including the use of artificial light, shift work, irregular or short sleep, sedentary activity, and unhealthy diet can disrupt the circadian rhythm. This disruption can result in the so-called Circadian Syndrome (CircS) which has been identified as a risk factor for a variety of chronic diseases. The concept of Circadian Syndrome (CircS) was first proposed by Zimmet et al in 2019. CircS has been shown to be a better predictor for cardiovascular diseases (CVD) than the metabolic syndrome (MetS) in adults in China and USA 1,2. Dietary patterns are found to be associated with CircS 3, whereby western dietary pattern was positively related, while prudent pattern was inversely associated, with CircS in the US adults. However, no prior study has investigated the association between fiber intake and CircS. We, thus, aimed to fill this research gap. We analysed data from 10,486 adults aged 20 years and above years who attended the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Fiber and other nutrients intake were assessed using two days 24 hours recall. CircS was derived from all five components of MetS (i.e. central obesity, elevated fasting glucose, elevated triglyceride, reduced HDL-Cholesterol and elevated blood pressure), in addition to short sleep (sleep duration <6 hours/day) and depressive symptoms (PHQ-9 score ≥5). A cut-off for CircS was set as ≥ 4 components. Multivariable logistic regression was used to assess the association between fiber intake and CircS. Mean age of participants was 50.3(SD 17.6) years, and 41.3% had CircS. The mean (SD) fiber intake was 7.8 (2.1), 12.9 (1.3), 17.9 (1.7), and 28.9 (8.2) g/day across the quartiles of fiber intake. The prevalence of CircS decreased across quartiles of fiber intake (44.5% in Q4 and 37.1% in Q1). In the multivariable logistic model adjusting for age, gender, ethnicity, energy intake, education and lifestyle factors, across the quartiles of fiber intake, the odds ratios (ORs) (95%CI) for CircS were: 1.00, 0.91 (0.76-1.08), 0.82 (0.70-0.96), 0.79 (0.63-0.98) (p trend 0.012), respectively. No significant interactions were found between fiber intake and race, gender, smoking, alcohol drinking, and physical activity, in relation to CircS. In conclusion, a high fiber intake was associated with a lower prevalence of CircS among US adults. The findings highlight the importance of fiber intake for the prevention of metabolic and circadian syndrome, suggesting a potentially accessible and cost-effective lifestyle approach to improve public health. Our results underscore the concern that most of the US adults had fiber intake below the recommended level. Longitudinal studies are needed to validate the findings in different populations.

The popularity of a vegan diet is growing worldwide. Data analysed from the 2018 NZ Attitudes and Values study showed that 1.1% of New Zealanders followed a vegan diet(1). Though there are potential nutrient deficiencies in a vegan diet, it is generally accepted that a vegan diet, with its emphasis on a variety of vegetables, fruit, grains, legumes, and pulses, has greater metabolic benefits than a Western-style diet high in red meat and processed foods and lower in plants(2). This observational cross-sectional study aimed to explore the dietary intake (4-day food diary) and metabolic health status (including anthropometry, blood pressure, lipids, body fat percentage, omega-3 index and glycaemic control) of adults who had been consuming a vegan diet for 2+ years. Participants (N = 212) were predominantly female (N = 155) with a mean (SD) age of 39.5 (12.4) years. Mean cardiometabolic markers of systolic and diastolic blood pressure, BMI, waist circumference, HbA1c, total cholesterol, LDL-cholesterol, HDL-cholesterol, Chol:HDL ratio and triglycerides were all below the thresholds for disease risk. Omega-3 index results <4% placed most participants (86.3%) in the high-risk category for heart disease. Many female participants (71%) had >30% body fat, compared to 5.3% of males. With reference to the AMDR (total fat 20-35%, carbohydrate 45-65% and protein 15-25%), the intake of total fat was at the upper end (males 34.4%, females 35.9%), carbohydrate was at the lower end (males 46.2%, females 44.7%), and protein was below the lower end (males 14.9%, females 14.2%). Saturated fat intakes ranged from 4.0-65.9 g/d, with a mean (SD) of 24.9 (10.5) g/d for males and 20.2 (9.9) g/d for females. The mean (SD) dietary fibre intake was much higher than the AI set by the Ministry of Health of 25g/d for females and 30g/d for males, at 55.0 (17.8) g/d for males and 43.4 (12.8) g/d for females, ranging from 10.9-133.9g/d. This is the first New Zealand study to examine the metabolic health and dietary intake of adult vegans. The results of cardiometabolic health markers indicate that the vegan diet confers cardioprotective benefits. However, the low Omega-3 index of most participants is concerning, which warrants longitudinal research to assess the level of risk conferred by a low Omega-3 index result in a population with no other cardiometabolic risk factors. The findings of the present study may help guide the growing New Zealand vegan community towards a nutritionally optimal vegan diet.

Pernicious anaemia (PA) is characterised by vitamin B12 deficiency due to autoimmune-mediated loss of gastric parietal cells and intrinsic factor, a specific transporter for the intestinal uptake of vitamin B12. PA is typically managed with lifelong intramuscular hydroxocobalamin injections every 2-3 months. However, this regimen lacks robust scientific validation and fails to account for varied symptomatic responses among patients, with many requiring more frequent injections(1).

The Pernicious Anaemia Society (PAS) is a patient-driven charity that identified 10 research priorities for PA through a James-Lind Alliance Priority Setting Partnership(2). PAS members were surveyed to build a PA Research Repository, exploring diagnostics, treatment, family histories, and comorbidities. This project aims to better understand and manage the condition by addressing these priorities and characterising a cohort of patients.

An online survey was designed using SurveyMonkey comprising 21 questions to collect data on demographics, mode and timing of PA diagnosis, diagnosed comorbidities, family history of PA or other autoimmune conditions, and management (type, regime and patient satisfaction). All questions were compulsory. The survey was sent to 3,482 PAS members (April-September 2022) via the PAS newsletter, email, and website. Chi-square tests were used to investigate associations between gender and survey responses. The study protocol and procedures received a Favourable Ethical Opinion.

Completed surveys were received from 1,191 PAS members (34% response rate). Among these, 971 (81%) had a confirmed PA diagnoses, and the cohort was predominantly UK-based (92%) females (81%) aged 23-90 years, with a wide age of onset (10 to 80 years, mean 49 years). Diagnoses were typically based on low serum B12 (40%), positive intrinsic factor (31%), and/or parietal cell autoantibodies (13%), with 7% diagnosed via the now obsolete Schilling test. Diagnostic delays were common, 39% of participants reported waiting ≥3 years for a diagnosis. Over half (59%) reported other micronutrient deficiencies upon diagnosis. Half reported additional autoimmune diseases, with one-third having family with PA or other autoimmune conditions. Treatment primarily involved hydroxocobalamin intramuscular injections (77%), with 48% following the recommended guidelines and 52% injecting more frequently. Females had higher prevalence rates of Hashimoto’s disease (27% vs 7%), asthma (33% vs 20%), and iron deficiency (49% vs 35%) (all p < 0.05).

This survey has established the first-ever PA research repository of over 1,000 participants offering initial insight into the complexities of PA, from varied age-of-onset and familial clustering to diagnostic challenges and treatment variability. These results support the need for improved diagnostic and treatment strategies, supporting the research recommendations made in the recent vitamin B12 deficiency NICE guidelines(3). It also highlights the potential of collaborative research with a patient-driven charity. Collaborative efforts aim to advance patient-centred PA research, improve treatment evaluation, and develop evidence-based approaches to managing this complex condition.

Vegan and vegetarian diets, lacking animal-based foods, increase the risk of vitamin B12 deficiency(1). Yet, there is limited current data on its prevalence among European ancestry individuals in Western Europe or the USA. This study aimed to provide a consensus on the prevalence of B12 deficiency among vegans and vegetarians of European ancestry residing in Western Europe or the USA.

We identified studies from our systematic review of “Functional Vitamin B12 Status Among Adult Vegans” to develop a narrative review of the prevalence of B12 deficiency based on biomarkers of B12 status among vegan and vegetarians. We then used pooled data from National Diet and Nutrition Survey (NDNS)(2) to calculate UK-specific prevalence information on B12 deficiency and insufficiency using the new NICE(3) criteria among vegan/vegetarian women of child-bearing age (WCBA) (age 18-45) compared with older women.

A total of six studies (2013-2022) with data on the prevalence of B12 deficiency were identified.

These studies were conducted on participants from UK, Norway, Spain, Czech Republic and US. Nearly all used different cut-offs to define B12 deficiency. Among vegans and vegetarians, the reported prevalence of deficiency ranged from 5-52% and 6-14%, respectively. Studies from Norway(4) and Finland(5) highlight low prevalence (5%) and no difference between dietary groups, possibly due to widespread supplement usage. The USA(6), indicated a higher prevalence of inadequate B12 intake among vegans and vegetarians compared to omnivours, with 8% of vegans and 6% of vegetarians exhibiting serum B12 levels < 148pmol/l. Similarly, results from Spain(7) noted subclinical deficiencies in 11% of participants, in both vegans and vegetarians. In the Czech Republic(8), cobalamin deficiency was noted in 15% of vegans, with 17% exhibiting deficiency (Serum B12< 100 ng/L). Notably, regular supplementation significantly reduced deficiency rates, emphasising its role in maintaining normal B12 levels. In the UK(9), only one publication reported B12 deficiency rates (SerumB12 <118pmol/L) among male vegans (52%) and vegetarians (7%). Using data from the NDNS and NICE guidelines, the prevalence of B12 deficiency was (defined as serum B12 < 133pmol/L and Holo-TC <25pmol/L) at 5-8% among vegetarian WCBA (Age 18-45); appropriate data on vegans was not available. B12 insufficiency (potential deficiency), defined by NICE as serum B12 < 258 pmol/L and Holo-TC < 70 pmol/L, translated to 75% of vegetarians within the WCBA cohort being defined as insufficient compared to 39% among older vegetarian women. A similar but more pronounced trend emerges for Holo-TC insufficiency, with 90% of vegetarians exhibiting inadequate Holo-TC < 70 pmol/L, compared to 58% of older women vegetarians and 65% of omnivores.

Few studies report B12 deficiency among Western European vegans and vegetarians, particularly for vegan WCBA. Existing data suggest a high risk can be mitigated with appropriate supplementation or adequately fortified foods.

Cow’s milk is the primary source of calcium in the NZ diet(1). The absence of dietary planning in a vegan diet can result in the individual unknowingly obtaining low intakes of calcium. Prolonged low calcium intakes can result in negative implications on bone mineral density by increasing the risk of osteoporosis later in life. The measurement of bone health parameters in NZ vegan adults have not been investigated. Therefore, we measured bone mineral density, markers of calcium homeostasis and assessed intake of essential nutrients for optimal bone health in vegans. This cross-sectional study included adults (>18yrs), who followed a vegan diet for 2 years minimum. Demographic and lifestyle information was obtained from questionnaires including previous history of bone fractures and background of familial osteoporosis. A 4-day food record was completed for analysis of calcium, zinc, protein, magnesium, phosphorus and vitamin C intake and compared to the Estimated Average Requirement (EAR)(2). Weight, height and BMI were obtained, bone mineral density was measured at the hip and spine via dual x-ray absorptiometry (DXA) and reported as Z and T scores. Plasma calcium concentrations were corrected for albumin. All values are presented as mean and standard deviation. The study included 212 participants, aged 39 ± 12.38 years, 71% female. T scores at the lumbar spine and femoral neck were −0.63 ± 1.22 (Z score: −0.29 ± 1.12) and −0.66 ± 1.00 (Z score: −0.24 ± 0.89), respectively. Nine participants had a Z-score of <-2.0 at the lumbar spine, and three at the femoral neck. Corrected calcium concentrations were 2.21 ± 0.33 mmol/L. Calcium intake was 917 ± 347.23 (range 195 to 2,429 mg/day) in all participants, which exceeded the EAR of 840 mg/day for adults aged 19-50 years. Men had higher intakes of calcium than women, 1,051 ± 363.7 mg/day (range 382 to 2,267 mg/day) vs. 867 ± 328.04 mg/day (range 194 to 2,428 mg/day), P-value <0.001. The main source of calcium in the vegan diet was tofu. The intake of protein (77 ± 27.80) g/day, magnesium (569 ± 181.05) mg/day, and vitamin C (145 ± 96.94) mg/day met the EAR, excluding vitamin and mineral supplements. However, the intake of phosphorus (1,472 ± 459.98) mg/day and zinc (10.6 ± 4.01) mg/day were below the EAR. The findings of this study suggest that bone health of vegans are not negatively affected by the exclusion of dairy in the diet, provided that appropriate dietary planning is included to avoid nutrient deficiencies associated with poor bone health. Despite mean intake of calcium exceeding the EAR, very low intakes demonstrated significant variations between participants.

Introduction: With the rising popularity of plant-based diets, assessing the nutritional status of individuals following these diets has become increasingly important, especially for vulnerable groups such as women of childbearing age (WCBA)(1). Vitamin B12, an essential nutrient primarily found in animal products, is of particular concern, as its deficiency can lead to serious health problems. Evaluating vitamin B12 status through multiple biomarkers provides a more comprehensive analysis, ensuring a thorough understanding of nutritional health in these populations.

Aims: To assess vitamin B12 status using a full battery of B12 biomarkers, including serum B12, Holotranscobalamin (Holo-TC) and total homocysteine (tHcy), among women of childbearing age adhering to vegan and vegetarian, compared to omnivorous diets, and to examine the association between vitamin B12 status and vitamin B12 dietary and supplement intake.

Methods: Repeated cross-sectional study based on data from four publicly available NDNS (2008-2012, 2012-2014, 2014-2015, 2016-2019) datasets (2,3). These were population-based surveys of randomly selected samples of adults which were conducted in their households.

Results

A total of 2,299 WCBA (6 vegans, 89 vegetarians & 2,204 omnivorous) across all the NDNS year groups, of which 521 had complete data for biochemical and dietary intake (participant number varies for each variable), were included in the study. Among WCBA group, the median dietary intake of B12 was 0.9mcg (IQR = 0.5) in the vegan group, 1.7mcg (IQR =2.0) in the vegetarian group, and 2.0mcg (IQR =2.4) in the omnivore group. Median B12 intake from both diet and supplements was 1.2mcg (IQR = 1.7) in vegans, 3.6mcg (IAR = 2.6) in vegetarians and 5.2mcg (IQR =2.6) among omnivores. No significant differences in B12 intake were observed between WCBA and older women (5 vegans and 48 vegetarians, age: 46-64) among vegan or vegetarian groups. We did observe significant differences in serum B12 (p = 0.02) and Holo-TC concentrations (p<0.001) but not for tHcy (p = 0.760) between these two age groups among vegetarians. Vitamin B12 biomarker data was available for only four vegans of which none were deficient, but half had insufficient B12 status based on serum B12 (<258 pmol/L) and Holo-TC (<70 pmol/L) levels. The proportion of B12 supplement users among vegans and vegetarians was 50% and 27%, respectively. Among all WCBA, of those with intake levels below 2.5mcg (current WHO/FAO recommended EAR for B12) (4) 41% had serum B12 levels below 200pmol/L compared with 23% when intake is above 2.5mcg. There were not enough data for vegans but 54% of vegetarians had serum B12 levels below 200pmol/L when not meeting the EU EAR.

Conclusion

There has been a considerable rise in the number of individuals taking up plant-based diets in Western society but data pertaining to this demographic remains notably scarce. Results presented here based on four combined releases of the NDNS program underscores a significant risk of B12 deficiency and insufficiency among individuals adhering to plant-based diets significantly exacerbated in WCBA and not adhering to an appropriate regimen of B12 supplement use.

Eggs provide several nutrients that have been linked to neurological function. Phospholipids, which comprise 30% of lipids in egg yolk, modulate neurotransmitter receptors and have been shown to lower reaction time in healthy adults(1). Eggs are also high in choline (340mg per egg), a building block for acetylcholine, a neurotransmitter involved in memory, learning and attention(2). Finally, eggs contain the omega-3 fatty acid docosahexaenoic acid (DHA) (25mg per egg), which has roles in neurological function including neurogenesis, synaptic plasticity and myelination(3). The impact of whole egg consumption on cognition has not been widely explored. This systematic review aimed to consolidate studies that investigated frequency of egg consumption or egg-supplemented diets on cognitive function. This review followed PRISMA guidelines and involved a search of five databases (Ovid Medline, Embase, CINAHL Plus, SCOPUS, and PsychInfo) from inception until April 2023. Included studies examined the link between whole chicken egg consumption and brain function, including cognitive decline, memory, risk-taking, reaction-time, decision-making, and executive function, in healthy adults (aged>16 y). All studies underwent risk of bias assessment. Twelve studies were included in the review. Four were prospective cohort studies, 4 were retrospective, 3 cross-sectional and 1 was a randomised controlled trial (RCT). Participant numbers, with the exception of the RCT, ranged between 178-9028 and were aged between 42-97 years. Duration of prospective studies varied from 2-5 years. Egg intake was measured via food frequency questionnaires (n = 8), 24-hr diet recalls (n = 2), a 4-day food record (n = 1) and a 7-day food record (n = 1). The RCT provided 2 DHA-fortified eggs/day compared to 2 whole eggs/day for 8 weeks. The primary outcome across 9 studies was cognitive decline, followed by memory (n = 7), reaction-time (n = 2), attention (n = 2), and executive function (n = 1). For outcome measures, studies used 9 different validated task-oriented tools (including the Montreal Cognitive Assessment n = 3, and California Verbal Learning Test n = 2), or 4 self-completed questionnaires. Several studies found no significant associations between egg consumption and cognitive decline (n = 4) or memory (n = 2). Conversely, 5 studies reported significant inverse associations between egg consumption and rates of cognitive decline. The RCT found that reaction-times were faster on both whole eggs and DHA-eggs after 8 weeks (p>0.05 between groups). Although conflicting results were found, more studies showed a greater frequency of habitual egg consumption to be associated with reduced cognitive decline. However, the variety of outcome measures across studies make direct comparisons challenging, preventing definitive conclusions about the impact of eggs on cognitive health. This review highlights the need for future RCTs.

There is a considerable body of evidence supporting the effects of increasing quantity of plantbased food consumption on health. Recently, there has been interest in the importance of diversity of plant-based food consumption, however, this remains less well understood(1). This study aims to (1) characterize the quantity and diversity of plant-based foods consumed, and (2) determine the association between plant-based food diversity, nutrient intake and demographic characteristics, in a nationally representative UK adult population.

This is a cross-sectional study using the National Diet and Nutrition Survey Year 9 (2016/2017) adult cohort. Participants completed estimated food and drink diaries over four days, which were then analysed to determine the intake of 258 distinct plant-based items within 2,202 discrete and composite foods. Items in all plant food categories (fruits, vegetables, grains, herbs, spices, nuts, seeds, fats, oils and beverages) were included. The mean daily diversity count was calculated by dividing total diversity counts by the number of food-diary days completed. Diversity was categorised into terciles to estimate low, moderate and high plant-based food diversity.

Multivariate regression analyses were conducted to identify predictors of diversity of plant-based food consumption.

Overall, 677 adults were included (58% female, 91% white, 29% with a degree). The median diversity of plant-based food intake was 8 counts/d (IQR 4). Diversity of plant-based food intake was categorised into the following terciles: low (median 5.5, IQR 1.8 counts/d), moderate (median 8.1, IQR 1.3 counts/d), and high diversity (median 11.0, IQR 2.3 counts/d). Vegetables were the largest contributors (22%) to diversity, followed by fats and oils (19%), and fruit (18%). The high diversity tercile had a higher fibre intake, compared to low diversity (median 11.5, IQR 4.9 g/d vs median 9.5 vs 4.0 g/d; p<0.001), and a lower trans fat intake (median 0.5, IQR 0.3 g/d vs median 0.6, IQR 0.4 g/d; p = 0.031). Higher annual income (+0.2 diversity counts/d per £5,000 increments, 95% CI 0.1−0.3; p<0.001), higher qualification levels (p<0.001), and following a vegetarian dietary pattern (p = 0.008) were significantly associated with higher daily diversity.

This is the first study to characterise plant-food diversity intake in the UK, showing the UK population consumes on average eight different plant foods a day. Higher plant-food diversity is linked to improved nutritional intake, and may offer an alternative strategy to optimise healthy diets. However, this remains to be confirmed in high quality randomised controlled trials, and the potential socio-economic disparities in relation to such a nutritional public health intervention need to be explored.

Rare earth elements, also known as lanthanides, are comprised of seventeen elements including lanthanum (La) to lutetium (Lu) in the periodic table(1). Despite their increased utilisation, little attention is given to them as emerging environmental contaminants and their associated health risks. The concentration of these elements in urban and agronomic soil is critical and may trigger bioaccumulation in plants and may enter the food chain. Also, the consumption of fertilizers in agricultural practices on a larger scale is a significant challenge. The REEs enriched fertilizers are a risk factor for contamination in soil and food(2). However, there is very limited data in the literature regarding the occurrence of these elements in a staple food such as rice. Thus, this study is aimed at quantification of REEs in 64 rice samples imported from different countries (Australia, India, Italy, Pakistan, Sri Lanka, Thailand, and Vietnam, including polished, brown, and parboiled) and sourced locally and consumed by the Australian population by using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The average concentration of REEs in Australian, Thailand and Vietnamese rice samples were quantified at 0.013- 2.974 µg/kg, 0.012-3.113 µg/kg, 0.009-0.919 µg/kg, respectively and were lower than other countries. The highest average concentrations of REEs were found in Pakistan (0.299-128.2 µg/kg), India (0.063-20.574 µg/kg), and Sri Lankan (0.022-11.522 µg/kg) rice samples imported to Australia. Scandium (Sc) and yttrium (Y) were found in the range of 107.463- 85.961 µg/kg. The pattern of light REEs (LREE) was more abundant than heavy REEs (HREE). This study did not include field experiments to find the translocation factors of REEs from soil to different parts of plant bodies, thus cannot establish the correlation between fertilizers and REEs concentration in rice grains. However, this study presented the general interpretation of REEs quantification in rice grains from different countries. The outcome of this study includes filling the subsequent knowledge gaps in analysing REEs in rice. This study also indicated the need to establish regulatory policies and monitoring programs for this type of staple cereals, aiming at promoting public health.

Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC)(1,2), yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence(3), DGBI characteristics are primarily described in Caucasian populations(2). We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a cross-sectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.

Dietary guidelines, such as the Eatwell Guide, play a crucial role in shaping public perceptions and behaviours regarding nutrition. In recent years, there has been a growing interest in diversifying protein sources, particularly towards more sustainable options such as plant-based and fungibased proteins.(1,2) However, the effectiveness of current dietary guidance in promoting these alternatives remains uncertain.(3) This study aims to seek views from healthcare and food professionals on whether an evolution of the Eatwell Guide to represent more protein-rich foods, and incorporate icons to denote origin of protein sources, could raise awareness of and support protein diversification.

Between 8th and 31st March 2024, an incentivised survey was distributed to members of the MyNutriWeb community, consisting primarily of healthcare and food professionals. The survey aimed to gauge respondents’ perceptions of whether an evolution of the visual representation of the Eatwell Guide, to represent more protein sources pictorially or within the description, and the use of icons within the plate image, would support them when talking through the protein section and support protein diversification, particularly in the form of plant-based and fungi-based proteins.

Of the 865 respondents, the majority (65%) were dietitians and nutritionists, with 12% being students and the remaining respondents representing various other food and health professions. While 83% (of 719 respondents) reported finding plant-based and fungi-based foods and drinks easy to identify within the Eatwell Guide plate image and description, only 12% were confident that those they support can easily identify them. However, a significant proportion (92% of 712 respondents) believed that updating the proteins description and images within the Eatwell Guide to showcase a more diverse range of proteins, will support people to consider more plant-based and fungi-based proteins within their diet. Furthermore, 68% (of 688 respondents) think adding plant-based and fungi-based icons to help themselves and other people to more easily identify plant-based and fungi-based foods and drinks would be ‘helpful’ or ‘very helpful’.

These findings underscore the potential for visual and descriptive enhancements of the Eatwell Guide, such as the inclusion of a more diverse range of protein foods and the use of icons, to improve the effectiveness of dietary guidelines in promoting protein diversification. By better representing plant-based and fungi-based options, the Eatwell Guide could facilitate informed decision-making and encourage the adoption of more sustainable dietary practices. Moreover, the high level of support expressed by respondents, including nutrition professionals, highlights the relevance and importance of incorporating visual aids to support the in-practice promotion of healthier and more sustainable dietary habits.

During the menopausal transition, women often encounter a range of physical and psychological symptoms which negatively impact on health-related quality of life (HRQoL)(1). Diet quality has previously been identified as a modifiable factor associated with mitigating the severity of these symptoms in peri-menopausal and menopausal women(2). We therefore explored the independent associations between adherence to a Mediterranean diet (MedDiet) and the severity of menopausal symptoms in peri-menopausal and menopausal women living in Australia. We also explored the association between MedDiet adherence and HRQoL in this same cohort of women. We conducted a cross-sectional study of Australian peri-menopausal or menopausal women aged between 40 to 60 years. An 86-item self-administered questionnaire was used to assess the relationship between adherence to a MedDiet and severity of symptoms. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS), the Menopause Rating Scale (MRS) was used to assess the severity of menopausal symptoms related to somatic, psychological and urinary-genital symptoms and the 36-item short form survey instrument (SF-36) was used to assess HRQoL. Multivariable linear regression analysis (and 95% CI) was used to investigate the independent association between adherence to a MedDiet, severity of menopausal symptoms and HRQoL subscales using one unadjusted and five adjusted predictor models. A total of n = 207 participants (50.7 ± 4.3 years; BMI: 28.0 ± 7.4 kg/m2) were included in the final analyses. Participants reported low-moderate adherence to a MedDiet (5.2 ± 1.8; range: 1-11). We showed that MedDiet adherence was not associated with severity of menopausal symptoms. However, when assessing individual dietary constituents of the MEDAS, we showed that low consumption of sugar-sweetened beverages (<250ml per day) was inversely associated with joint and muscle complaints, independent of all covariates (β = −0.149; CI: −0.118, −0.022; P = 0.042). Furthermore, adherence to a MedDiet was positively associated with the physical function subscale of HRQoL (β = 0.173, CI: 0.001, 0.029; P = 0.031) and a low intake of red and processed meats (≤ 1 serve per day) was positively associated with the general health subscale (β = 0.296, CI: 0.005, 0.014; P = <0.001), independent of all covariates used in the fully adjusted model. Our results suggest that diet quality may be related to severity of menopausal symptoms and HRQoL in peri-menopausal and menopausal women. However, exploration of these findings using longitudinal analyses and robust clinical trials are needed to better elucidate these findings.

Climate change is strongly linked to production of livestock(1,2) and national recommendations are to reduce meat consumption, especially ruminant meat(2), as part of a more sustainable diet. However, this recommendation in isolation is no guarantee that diets would be healthy or have lower greenhouse gas emissions because foods are eaten within the context of meals and a wider diet. In this study the role of meat within the context of UK meals was examined to understand the potential knock-on consequences for meal structures.

Cross-sectional dietary intake data from UK National Diet and Nutrition Surveys(3) (2008- 2019) were analysed to compare the composition of 287,719 eating occasions. Mixed-effects logistic and gamma regressions models were used to determine the likelihood of consumption and, when eaten, the quantity consumed of selected food groups based on the coincidence of other foods in the meal. Models adjusted for age (1.5 ≤ years ≤ 96), gender, and time of day in addition to a random intercept for participants.

Of the eating occasions examined, 30% contained meat, rising to 42% for evening meals (5pm to 8pm). Meats were a significant determinant of the type of starchy foods within a meal, for example the likelihood of pasta was higher with beef (OR 1.06 (95% CI 1.04, 1.07) per z-score change in beef in the meal) than poultry (OR 0.87 (0.85, 0.87)) whereas rice was more likely to be eaten with chicken (OR 1.44 (1.42, 1.46)) than beef (OR 1.06 (1.04, 1.08)). The likelihood of potatoes in a meal increased with all meats, but the likelihood of bread was lower in meals containing meat, except for bacon and ham (OR 1.30 (1.30, 1.33)). The presence of meat, of almost any type, in a meal was predictive of vegetables in the meal. On average the quantity of meat increased the quantity of vegetables in the meal by approximately 11.2% (95% CI 9.5, 12.8), 8.7% (6.0, 11.4), 8.1% (5.5, 10.8), and 3.9% (2.7, 5.2)% per 100g increase of beef, lamb, pork, and poultry respectively.

Recommendations to reduce meat consumption must consider the wider impact on the whole diet

as meals are restructured. Observed meals indicate the combinations of foods currently consumed, and how people may change eating patterns if they reduce meat consumption. The consequence of reducing meat in meals may change the choice of starchy elements. Switching from beef to poultry would likely increase rice consumption and reduce use of potatoes and pasta, attenuating the net reduction in emissions. However, since meat was positively predictive of the presence and quantity of vegetable in meals, reducing meat content may, in the short term, have negative implications for public health as people restructure meals.

Food choice is complex and is heavily influenced by the environment one lives in(1). Pacific Island food environments, including those in Tonga, have changed considerably in recent years, making healthier food choice more challenging(2). A widespread nutrition transition across the region has contributed to an increase in the availability of, and accessibility to, highly-processed foods, and high rates of diet-related non-communicable diseases(3). While system change is needed to support the availability, accessibility and affordability of healthy foods, nutrition education plays an important role in supporting individuals, communities, and populations to navigate their rapidly changing food environments, and to encourage healthy food choice and behaviour change. Approaches to nutrition education in the Pacific Islands region vary and do not always consider the socio-cultural aspects of the food environment, especially when focusing on fruit and vegetable consumption. This work was driven by an intent to develop contextually appropriate nutrition education plans using a structured process, Design Online(4). However, to develop a nutrition education plan a critical analysis of the current motivators and facilitators for the behaviour are required. When reviewing the scientific literature there is limited information on determinants of food choice within Tonga, and more broadly within the Pacific Islands context. Therefore, the aim of this cohort study was to qualitatively explore and document the motivating and facilitating determinants of fruit and vegetable consumption in Tonga. Data collection took place during August and September 2023 on the main island of Tongatapu. Semi-structured interviews (n = 5 men, 3 women) and a focus group (n = 4 women) based on the most appropriate method of engaging with participants, were conducted in Tongan. Guiding questions were derived from Design Online and proposed within the following categories: motivating determinants and facilitating determinants. Interview responses were qualitatively analysed using an inductive content analysis model. Key categories for motivating determinants included health and nutrition knowledge, normal consumption patterns, availability and access, production, financial considerations and preferences, perceptions and practices. Key categories for facilitating determinants included education, community engagement, environmental factors, food preference, finance, and accessibility. While this work has explored motivating and facilitating determinants for fruit and vegetable consumption in Tonga with a small sample, it makes an important contribution to the limited literature. The findings of this study can be used to underpin activities, such as the design of nutrition education plans. The findings also provide a foundation for further exploration of determinants of food choice. This study was undertaken on the main island of Tongatapu, but it is of interest to explore determinants with communities who live in the outer islands, and at different time points during the year to reflect seasonality.

Fruits and vegetables are rich in dietary fibre, vitamins and minerals making them beneficial for health. The UK’s Eatwell Guide (EWG)(1) recommends fruits and vegetables make up 40% of the diet (by weight), but on average they contribute less than 29% to the UK diet(2). Prominent product placement can boost sales. We explored the effect of placing salads next to ready meals in a retail setting, on salad and total fruit and vegetable sales.

In a 12-week intervention (July – October 2021), four bagged salad products were shelved above Italian ready meals in 23 stores. Salads displayed a ‘healthy’ on-pack symbol and shelf signposting encouraging customers to ‘add salad to their baskets for a balanced meal’.

Two matched control store groups were identified, based on store area demographics (n = 23 stores) and store-level pre-intervention bagged salad and Italian ready meal sales (n = 21 stores), accounting for external sales influences, e.g. weather, supply chain shocks and Covid-19 lockdown behaviours. Transactions were shared by the retailer for 2 years before, 3 months during, and 9 months post-intervention.

Two years of pre-trial transactions (units and weight) were aggregated to the store level to produce an interrupted time series model quantifying changes in store-level daily sales of promoted salads, versus a predicted counterfactual. Analysis was repeated in control stores.

Within-group change in mean basket proportion (by weight) by EWG segment was examined via the Wilcoxon signed-rank test for difference, comparing the intervention period with two timematched baseline (BL) periods (BL1=July – October 2019, and BL2=July – October 2020).

In the first three weeks of the intervention, unit sales of promoted salads increased by 35.74% (CI 25.91 - 45.72, p<0.001) vs counterfactual in the intervention stores. However, over the whole 12weeks, unit sales were down 18.34% (CI -26.17%, -10.35%, p<0.001) vs counterfactual. A similar trend was observed across control groups, indicating changes were independent of the intervention.

In intervention stores, fruits and vegetables made up 38.75% of baskets at BL1, but declined significantly over time, down 4.12 (p<0.001) percentage points in the intervention period vs BL1 and 1.43 (p<0.001) vs BL2. The proportion of composite (multi-ingredient) dishes rose; up 0.74

(p<0.001) percentage points vs BL1 and 1.35 (p<0.001) vs BL2, as did discretionary items; up 0.91 (p<0.001) percentage points vs BL1 and 0.45 (p<0.001) vs BL2. Similar patterns were observed in control stores.

Salad sales increased at the start of the intervention relative to predicted sales, but the same change was observed in control stores meaning it cannot be attributed to the trial. Pre-intervention fruit and vegetable purchases with the retailer aligned with the EWG, indicating shoppers already had healthy purchase patterns which may have limited intervention effectiveness.

Regulations restricting promotion of some High Fat, Sugar, Salt (HFSS) products within “restricted areas” (RAs) (e.g. end of aisles) of eligible supermarket stores came into force in October 2022 in England.

To evaluate the prevalence of HFSS products, Front-of-Pack Nutrition Labelling (FOPNL) characteristics and categories of foods sold within RAs in a sample of supermarket stores, with respect to the Food (Promotion and Placement) Regulations 2021.

A cross-sectional survey of products in RAs in three supermarkets.

Following the manual identification of each supermarket’s RAs, from November 2022-January 2023, these were photographed and the display of products and their Front-of-Pack Nutrition Labelling (FOPNL) recorded. Products were identified using corresponding online supermarket webpages, from which data collected included product name, nutrition, and ingredients. This information was used to allocate each product to a category (e.g. ready meals) that was either in or out of scope of the Regulations. Evaluation of each product’s healthfulness was performed using the UK Nutrient Profiling Model (to determine HFSS status) and UK Multiple Traffic Light criteria to calculate number of inherent (i.e. possessed regardless of their display) Red Traffic Lights (iRTL). Prevalence of HFSS, FOPNL and iRTL were calculated as a proportion (%) of total products displayed in the included RAs. Associations between the prevalence of these characteristics were performed using chi-squared tests.

Across the three stores, 86 RAs were identified, with data collected from 32 RAs displaying 679 food products, most of which fell into product categories considered out-of-scope of the Regulations (64%, n = 435). Across included RAs, the prevalence of HFSS products within all in and out-of-scope categories, was 42 % (n = 282). Half of all products (53%, n = 357) displayed FOPNL, and 16% possessed 1, 2 or 3 iRTL, including both HFSS and non-HFSS items. Across those product categories in-scope of the Regulations (n = 245), prevalence of HFSS was 17% (n = 42). These HFSS products were less likely to display FOPNL compared to non-HFSS products (2= 25.01, p < 0.001).

Following the implementation of The Food (Promotion and Placement) Regulations, intended to create healthier food retail environments, products sold across Restricted Areas of three eligible supermarkets included those in categories in and out of scope of Regulations with varied prevalence of less-healthy (HFSS) products, display of FOPNL, and possession of iRTL across both. This study is a first researcher-led evaluation of the recently regulated consumer-facing instore environment, with implications for future policy impact evaluation.

Cerebral palsy (CP), or to use the Te Reo term “Hōkai Nukurangi”, is an umbrella name for a group of permanent neurodevelopmental disorders, affecting movement and posture(1), and is the most common childhood onset physical disability globally. The available literature on the nutritional status of children with CP describes high rates of malnutrition, however data appears to be skewed towards children of higher levels of impairment impacting functional independence. Less is known about the nutritional status of children with lower levels of impairment. The aim of the “Eat, Sleep, Play-CP” study was to evaluate total energy intake, total protein intake and the timing of protein intake in relation to physical activity for children with CP across all functional levels living in Aotearoa New Zealand. Children with CP aged 5-12 years were invited to participate in an observational assessment of dietary intake using parent reported 24-hour dietary recall (Intake 24) on three non-consecutive days, accompanied by a questionnaire capturing self-reported sleep and physical activity patterns. Body composition was assessed via whole body dual energy X-ray absorptiometry scan. Nine participants (6 males, median age: 10 years, n = 2 Māori), across Gross Motor Function Classification System levels I-IV, and Eating and Drinking Classification System levels I-III took part in the study. The median total energy intake was 7267kJ/d (range 5355-10731.96kJ/d), and median protein intake was 67g/d (range 49-111g/d). According to the Nutrient Reference Values for Australia and New Zealand (NRV)(2), 3 of the 9 participants (33%) were within the recommended range for energy intake according to their age and reported physical activity levels. Of the other 6, 4 were below and 2 were above the recommended ranges. All 9 met the recommended protein intake (NRV). Participants had a median percentage body fat of 40% (range 20-46%), and non-fat mass of 58% (range 52-76%). Five participants fell within the overweight or obese range for their age and sex, three of whom were within the recommended range of total energy daily intake according to NRVs. This outcome may indicate that for some children with CP, recommendations could be over-estimating the actual requirements. These early results may bring in to question current practice around guidance for energy intake requirements for children with CP and their whānau to support healthy body composition. Further investigations are needed to establish whether specific energy intake guidelines are required for children with CP.

Poor dietary habits are associated with the development of non-communicable diseases(1). Most strategies implemented to enhance population diet quality follow a “one-size-fits-all” standardised approach, often neglecting individual preferences and requirements. Evidence suggests that personalised nutrition (PN) advice, tailored to an individual, can improve dietary intakes(2). This research investigates participants’ subjective feedback from the EatWellUK-2 randomised control trial that compared PN advice versus general dietary guidance, both delivered via eNutri, a web app, developed at the University of Reading. eNutri delivers automated food-based nutrition advice tailored to the user based on their dietary intake recorded by a food frequency questionnaire (FFQ)(3).

Participants were disease-free UK adults (>18y) who were randomised to the PN or control group. Participants completed the eNutri FFQ, then automatically received via the app either advice tailored to their dietary intake (PN group) or general population advice based on the UK’s Eatwell Guide (control). Following a 12-week intervention, the FFQ was repeated and participants completed a feedback questionnaire containing open-text and Likert questions assessing agreement with statements (strongly disagree, disagree, neutral, agree and strongly agree). MannWhitney U tests compared the mean ranks between the PN and control groups for each question. Data are presented as percentages of participants who felt positively about each statement based on “agreed” plus “strongly agreed” responses. The study received ethical approval from the University of Reading Research Ethics Committee (08/19) and was registered at ClinicalTrials.gov (NCT03897972).

Participants (90% female) had a mean (SD) age of 46 (15) y and BMI of 25.8 (6.1) kg/m2. When asked about the advice received, the responses of the PN group (n = 54) were more positive that “it encouraged me to eat healthily, even if only for short time” (p = 0.045, PN 55.6% vs control 41.8%) and “it was clear what changes I needed to make to improve my diet” (p = 0.011, PN 73.6% vs C 51.8%). When asked to provide an “app review” of eNutri, the control group (n =55) described their advice as “too general” and “readily available elsewhere”, while the PN group said it contained “varied and realistic examples”, and the advice was “very clear”, “helpful” in relation to choosing “better foods to eat” and allowed people to “assess your own goals”.

Participant feedback favoured PN over general population advice as it provided encouragement and clarity about which dietary changes would benefit each individual. Together with the quantitative results from the EatWellUK-2 study, which are still being analysed, these findings will help to assess eNutri’s potential as a useful tool to encourage UK adults to adopt healthier dietary behaviours.

Folic acid (FA) and iodine supplements are recommended by the Ministry of Health (MOH) for pregnant and/or lactating women in New Zealand (NZ)(1). Evidence suggests that many NZ women are not just taking FA and iodine in the form of a single-nutrient supplement (SNS) but are taking FA and iodine as part of a multivitamin supplement (MVS) which may or may not contain the recommended doses, and some are using a combination of both(2). No NZ study has examined the daily dose taken from both SNS and MVS for both FA and iodine across all time periods (2, 3). The aim of this study was to investigate what nutritional supplements containing FA and iodine were taken by postpartum NZ women, preconception, during the three trimesters of pregnancy and post-partum, and examine how well the women’s supplement use aligned with the NZ MOH recommendations. This cross-sectional observational study utilised data gathered on FA and iodine supplement use from an anonymous survey between February and August 2022. Descriptive statistics including frequency and percentages were reported. Folic acid and iodine weekly intakes from SNS and MVS were calculated by multiplying the amount of nutrient in each supplement, with the number of times per day taken, and the average number of days taken per week reported. A total of 584 women were included in the analysis. In addition to the SNS for FA (0.8mg and 5mg) and iodine (150 ug), women took 28 different MVS. Fifty-eight percent (preconception; 30% from SNS, 18% from MVS, and 10% from both) and 96% (1st trimester pregnancy; 61% from SNS, 17% from MVS, and 19% from both) of women took FA containing supplements. More than 75% of women reported taking iodine containing supplements during pregnancy (1st and 2nd trimesters: 93%, 3rd trimester: 89%) and postpartum (76%).Approximately 60% took SNS, 18% took only MVS and 14% took both. Based on the MOH recommendations, only 30% (preconception) and 62% (1st trimester) achieved sufficiency of FA supplementation at 0.8mg/day; 35% (preconception) and 69% (1st trimester) achieved sufficiency of FA at 5mg/day; around 50% women achieved sufficiency of iodine supplementation at 150 µg/day during pregnancy while only 37% during postpartum. The balance either took none, an insufficient dose or a dose that exceeded the recommended dose and many took them during non-recommended periods (FA after the 1st trimester; iodine preconception). Most women reported taking FA and/or iodine containing supplements at some point before, during and after their pregnancy. However, it is concerning that a large number of women do not seem to be adhering to the MOH recommendations for FA and iodine supplementation.